DXM- What Is It and Why Is It Important?

Now that we have discussed the growing problem of OTC medication abuse, we will now look at the substance that is most commonly abused. Dextromethorphan is found in more than 120 over the counter cold medicines and when taken in higher than recommended doses it can produce a high feeling. It's street names include DXM, robo, and skittles. When taken in normal doses (15-30 mg three to four times a day) DXM is an anti coughing agent and side effects are extremely rare.

The troubling thing about DXM is that is a semi synthetic morphine derivative meaning it is structurally similar to heroin and morphine but does not act on the same receptors. Instead at high doses DXM performs more like ketamine or the illegal street drug PCP. High doses of DXM can even cause the violent and disturbing behavior observed with PCP usage.

Most cases of abuse observed in the past has been done using high doses of OTC cough syrup, but more recently use of capsules and tablets to get high has increased. Powdered forms of DXM are sold illegally on the internet and the DEA has even seen DXM mixed with illegal street drugs such as ecstasy and methamphetamine on the black market. With these other forms of DXM available the high has gotten more dangerous. Teens especially tend to use DXM products in combination with alcohol making the risk that much greater, deaths have even been reported.

Overdoses are particularly troublesome when it comes to DXM. Almost every over the counter product out there contains a different amount of DXM and may have many other drugs in them as well. Just 4 ounces of Robitussin or half a bottle has enough DXM to cause an overdose. Products that contain both DXM and antihistamines taken at high levels can cause anticholinergic toxicity in addition to DXM toxicity. Also, approximately 5-10% of Caucasians metabolize DXM poorly, making them more prone to overdose and death from toxicity.

What parents and nurses should take away from this is that DXM is a serious drug that is just as dangerous as a street drug in high levels. It is even under DEA review to be considered a controlled substance.

Sources:

DEA Office of Diversion Control

EMS Responder